Jiang YE, Lyu QQ, Lin F, You XT, Jiang ZL. Hyoid-complex elevation and stimulation technique restores swallowing function in patients with lateral medullary syndrome: Two case reports. World J Clin Cases 2020; 8(6): 1142-1149 [PMID: 32258085 DOI: 10.12998/wjcc.v8.i6.1142]
Corresponding Author of This Article
Zhong-Li Jiang, MD, PhD, Director, Doctor, Full Professor, Postdoc, Department of Rehabilitation Medicine, Sir Run Run Hospital, Nanjing Medical University, 109 Longmian Avenue, Nanjing 211100, Jiangsu Province, China. jiangzhongli@njmu.edu.cn
Research Domain of This Article
Rehabilitation
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Yu-Er Jiang, Qian-Qian Lyu, Feng Lin, Xue-Ting You, Zhong-Li Jiang, Department of Rehabilitation Medicine, Sir Run Run Hospital, Nanjing Medical University, Nanjing 211100, Jiangsu Province, China
Yu-Er Jiang, Qian-Qian Lyu, Feng Lin, Xue-Ting You, Zhong-Li Jiang, Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
Author contributions: Jiang YE performed the swallowing treatment for the two patients, reviewed the literature, and drafted the manuscript; Lyu QQ was the bedside clinician of Case 1 and contributed to manuscript drafting; You XT was the bedside clinician of Case 2 and contributed to manuscript drafting; Lin F and Jiang ZL were the proposers of the technique and responsible for the manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Zhong-Li Jiang, MD, PhD, Director, Doctor, Full Professor, Postdoc, Department of Rehabilitation Medicine, Sir Run Run Hospital, Nanjing Medical University, 109 Longmian Avenue, Nanjing 211100, Jiangsu Province, China. jiangzhongli@njmu.edu.cn
Received: November 25, 2019 Peer-review started: November 25, 2019 First decision: February 20, 2020 Revised: February 24, 2020 Accepted: March 5, 2020 Article in press: March 5, 2020 Published online: March 26, 2020 Processing time: 121 Days and 10.7 Hours
Abstract
BACKGROUND
A swallowing disorder may occur following a brainstem stroke, especially one that occurs in the swallowing centers. Lateral medullary syndrome (referred to as LMS), a rare condition in which a vascular event occurs in the territory of the posterior inferior cerebellar artery or the vertebral artery, has been reported to lead to more severe and longer lasting dysphagia.
CASE SUMMARY
We report two patients with dysphagia due to LMS and propose a novel technique named hyoid-complex elevation and stimulation technique (known as HEST). The two patients had no other functional incapacity back into life, but nasogastric feeding was the only possible way for nutrition because of severe aspirations. Swallowing function was evaluated by functional oral intake scale, modified water swallow test, surface electromyographic signal associated with video fluorography swallowing study to assess the situation of aspiration, pharyngeal residue, pharyngeal peristalsis, upper esophageal opening and the ability of deglutition. Both patients were treated with the HEST method for dysphagia and recovered quickly.
CONCLUSION
HEST is effective for shortening the in-hospital time and improving the quality of life for patients with dysphagia who suffer from LMS and likely other strokes.
Core tip: For dysphagia treatment of lateral medullary syndrome, hyoid-complex elevation and stimulation technique is a novel technique that combines balloon dilation with electromyography-triggered electrical stimulation to restore swallowing function. It is easy to operate, safe for patients, and effective for shortening the in-hospital time. This case report suggests a new treatment for dysphagia patients, especially for those who cannot achieve the expected effect with traditional therapy.
